JACC Clin Electrophy:导管消融对心房肺动脉Fontan术后心律失常安全有效

2018-11-11 国际循环编辑部 国际循环

房性心律失常是心房肺动脉(AP)Fontan术后患者发病及死亡的重要原因。JACC: Clinical Electrophysiology发表的一项最新研究评估了成年AP Fontan术后患者经导管消融后房性心律失常的机制、近期结局及长期心律失常负担情况。

房性心律失常是心房肺动脉(AP)Fontan术后患者发病及死亡的重要原因。JACC: Clinical Electrophysiology发表的一项最新研究评估了成年AP Fontan术后患者经导管消融后房性心律失常的机制、近期结局及长期心律失常负担情况。



研究共计连续入选1998~2017年,60例房性心律失常消融治疗患者,其中42例接受AP Fontan术,平均年龄为(31±8)岁;记录每例患者诱发及消融的心动过速数量以及疑似临床心动过速的消融情况,采用12点临床心律失常严重程度评分评估长期心律失常负担。

共计56例(93%)患者可诱发心房内折返性心动过速(IART),2例(3%)患者可诱发房室折返性心动过速,1例患者存在房室结折返性心动过速。每例患者诱发的心动过速的平均数量为2.3次,IART的关键性峡部可位于体静脉心房的外侧(n=10)、下侧(n=8)、后/后外侧(n=16)及肺静脉心房(n=4)。所有被诱导的心动过速中62%可实现消融,25%的患者实现了消融至少一次而非全部心动过速,13%未实现心动过速消融。

此外,50例(83%)患者因疑似临床心律失常而接受消融。无论所有可诱导的心动过速均被消融还是仅疑似临床心律失常被消融,导管消融均可使3个月、6个月、12个月及24个月时心律失常评分显著降低。另外,研究期间共计12例(29%)患者至少再次接受重复消融手术,两次消融的平均时间间隔为(2.7±3.0)年。整个研究期间未见围术期死亡、卒中及心脏压塞情况发生。

上述结果提示,导管消融对AP Fontan患者安全有效,可显著减轻心律失常负担。

原始出处:
Benjamin M. Moore, Robert Anderson, Ashley M. Nisbet, et al. Ablation of Atrial Arrhythmias After the Atriopulmonary Fontan Procedure. JACC: Clinical Electrophysiology. Oct 2018.

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    2019-04-16 hbwxf
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    2018-11-13 sodoo

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